Let’s Talk About Risk
Review the agenda below:
Section 1 – Risk Adjustment Basics
This section will cover basic concepts and terminology in the CMS-HCC Model of Risk Adjustment.
- What is an HCC?
- Why are HCCs important?
- How is a risk score calculated?
- What is the value of an HCC?
- What are the most common HCCs?
Section 2 – Rules of the Road
This section will cover ICD-10 Guidelines and other “rules” related to clinical documentation and coding within the CMS-HCC Model of Risk Adjustment.
- When should a diagnosis be coded?
- How often can a diagnosis be coded?
- What clinical documentation is needed to support the diagnosis?
- Is it okay to code for resolved conditions?
- Would it be acceptable to code a diagnosis documented as “suspected” in an outpatient setting such as a provider’s office?
Section 3 – HCC Coding
This section will review the most common HCC’s for Medicare enrollees based on MedPAC data.
- What are the twenty most common HCC categories for Medicare enrollees?
- What are the most common ICD-10 codes included in each category?
- How can clinical documentation impact code selection?
- What are common errors leading to inaccurate risk scores?
Section 4 – Tips for Success
This section will cover simple tips that will make a big impact. At the end of this lesson you will be able to work smarter not harder.
- What should be included in the problem list?
- Why does clinical documentation need to clarify active vs. history of?
- What small changes can you start making today that will have a big impact on the accuracy of your risk scores?
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